Despite the range of contraceptive methods currently available, approximately half of pregnancies in the U.S. are unintended. Emergency contraception (EC) is post-coital contraception that can prevent pregnancy. Women who seek EC may be at increased risk for unintended pregnancy and negative reproductive health outcomes after a precipitating act of unprotected sex and also within the immediate future. Because of the over-the-counter age restriction, limited “behind-the-counter” access at pharmacies, and the retail cost, many women seek EC by obtaining a prescription from a medical provider. The public health benefit of women seeking EC lies not only in the immediate chance to prevent a pregnancy, but also in the opportunity to help women adopt effective contraception and improve health behaviors.

Little is known about reproductive health outcomes associated with use of EC through various clinical routes, especially for women who obtain EC with a prescription without a clinic visit. Approximately 25,000 prescriptions for EC are dispensed to women through various clinical routes at Kaiser Permanente Northern California (KPNC) annually. The regional advice-and-appointment call centers (AACC) operated 24 hours every day and gave women over 10,000 prescriptions for EC in 2011. In addition, women can obtain prescriptions for EC through other routes such as telephone appointments or on-line encounters with a provider.

We propose a retrospective cohort study of women who receive EC prescriptions at KPNC through: 1) a clinic visit; 2) the AACC; and 3) other non-clinic visit routes. The objective of this study is to utilize information from KPNC's Electronic Health Record to assess subsequent use of contraception, EC, pregnancies and related reproductive health outcomes among women obtaining EC through various clinical routes. This study will provide new information about health behaviors and outcomes after use of EC and help providers understand how to optimally assist women who have unprotected sex.